EpiPen: The pharmaceutical epidemic

Allergies can be annoying. You’re restricted from eating certain foods and trying out certain things, but sometimes, allergies can be more than just annoying; they can be fatal. Instead of itchy rashes and runny noses, those with severe allergies can suffer from anaphylaxis, when your airways swell and close in minutes.

Such a reaction can be treated simply enough with epinephrine — or adrenaline — a hormone naturally produced by the adrenal glands. It opens your airways, and is very cheap, at less than US$1/ml. Most people only need less than a third of that to buy them enough time to get to a hospital.

Here’s the catch — epinephrine must be delivered quickly, and in proper amounts. Those suffering from anaphylaxis obviously cannot administer the drug themselves, and most other people do not know how to, and how much.

The Revolutionary Pen

Enter the EpiPen, a patented auto-injection device containing the correct dosage that can be easily administered even by children. First introduced in 1977, it was bought over in 2007 by Mylan, a pharmaceutical company who sold it for US$57. In Singapore today, the price ranges from $135 – $185.

Over time, however, by May 2016 it retailed at around US$600 in the US — an astounding mark-up of over 400%, and the whole world is flipping out.

In America alone, there are roughly 40 million people at risk of anaphylactic shocks. In Singapore, a 2014 study of 108 anaphylaxis attacks in a paediatric emergency centre showed that peanut allergy was the top cause, accounting for 13 of the cases. Another 2014 study involving 2,737 Singaporean children found roughly 426 of them with shellfish allergy — the second common cause of anaphylaxis.

You would think that with so many people carrying EpiPens around, Mylan would be content with its profit, which was nearly US$1.7 billion in US market alone last year. However, in America, with few viable competitors, no generic version approved by the government, and the constant need to replace the EpiPens every year because they degrade, Mylan is in a unique position, and the public has no choice but to fork out the money or risk death.

The Realities of Life

Many who cannot afford EpiPens anymore are filling syringes with epinephrine themselves, which is an extremely tricky and dangerous alternative. This is one of the cruelties of drug pricing — the burden falls most heavily on those least able to pay it. What’s more, while the prices are always increasing, the drugs remain the same ones approved by the government years ago; there hasn’t been any pharmaceutical innovation, just a substantial price increase.

On the other hand, while this EpiPen farce may seem shocking, it fits a pattern. Prescription drug prices are rising across the board, despite the negative backlash from the public, for a few reasons: firstly, the pharmaceutical industry needs to recoup their commissions to intermediaries by listing higher prices. Secondly, drug makers are hoping to profit while they can, before their patent expires. Last but not least, millions are spent annually on often unnecessary marketing, and so that “cost”, an amount that they don’t explicitly make clear to the public, must be recovered.

To quote Mylan’s CEO, pharmaceutical companies are just “running a business… a for-profit business.” Price hikes for pain relief and lifestyle drugs pale in comparison with the exorbitant prices of important drugs, just because consumers of the latter can’t say no, and it’s like the companies are gleefully gambling with people’s lives for money. Think Martin Shkreli and his 5,000% price hike of Daraprim, the only approved AIDS medication. However, public backlash seems to have had an effect on Mylan this time — just a few days ago it announced that it will offer discounts and a generic version at US$300. Unfortunately, this is how the free market works, so when and where should the line be drawn, if any?

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